[Oral EBV-associated diffuse large B-cell lymphomas in HIV-negative immunocompromised patients]

Area of Science:

• Oncology
• Immunology
• Oral Pathology

Background:

• Diffuse Large B-cell Lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma (NHL) in adults, accounting for 30-40% of cases.
• The etiology of DLBCL is not fully understood, but Epstein-Barr virus (EBV) induction is a suspected factor, particularly in immunocompromised individuals.
• Patients with congenital or acquired immunodeficiency are at higher risk for developing DLBCL.

Observation:

• Case 1: A 39-year-old female with myasthenia gravis on long-term azathioprine developed EBV-associated DLBCL, plasmablastic subtype, in the maxillary alveolar ridge.
• The lesion presented as necrotizing periodontitis resistant to treatment. Complete remission was achieved after chemotherapy.
• Case 2: A 56-year-old male developed EBV-associated DLBCL, immunoblastic variant, in the maxillary alveolar ridge 7 weeks post-heart transplant, on azathioprine and cyclosporine A.
• The clinical presentation was a non-painful swelling with ulceration. Tumor excision and radiation led to no recurrence over 15 years.

Findings:

• Both cases highlight an increased risk of oral malignant B-cell lymphomas as an adverse effect of immunosuppressive therapy.
• Epstein-Barr virus (EBV) was detected in tumor cells, confirming its role in the pathogenesis of oral DLBCL in immunocompromised patients.
• Oral DLBCL can present with varied and nonspecific clinical signs, necessitating prompt diagnostic evaluation.

Implications:

• These findings underscore the importance of considering oral DLBCL in the differential diagnosis of persistent oral lesions in immunosuppressed patients.
• Early diagnosis through biopsy and specialized hematopathology work-up is critical due to the potential for rapid dissemination of oral DLBCL.
• Management strategies may involve chemotherapy, surgical excision, and radiation therapy, depending on the specific case and disease stage.